Published: April 2024 (February 2024 version)
GiveWell makes grants to fund some of the most cost-effective programs we’ve found at saving lives.
Because the initial outputs of these grants are so inexpensive (for example, it costs about $7 to distribute preventive malaria treatment to a child through one malaria season), many people are surprised at how expensive it can be to save a life, even for the most cost-effective programs. Over the past several years, our models for grants to our Top Charities have typically estimated an average cost between $3,000 and $5,500.1
We hope that this 2023 example helps illustrate the discrepancy in cost between the initial outputs and the cost to save a life.
This example does not reflect what we estimate this program's cost to save a life will be in the future. We generally expect the cost to save a life to increase over time.
The cost to save a life for one grant
Below we’ll explain our 2024 estimate for how $3,000 could save a life in Nigeria by funding the distribution of preventive malaria treatments through Malaria Consortium. Malaria Consortium delivers monthly courses of antimalarial medicines in locations where malaria is highly seasonal. The numbers below are based on a $6.4 million grant to Malaria Consortium we approved in 2023 and funded with our Top Charities Fund. We estimate this grant will provide more than 4.6 million monthly courses of preventive malaria medication and save more than 2,000 lives.
We chose to highlight this grant because it’s fairly representative of many of the grants we make: it funds a program we’ve supported for years in a region we expect to continue supporting in the future. This grant may be more cost-effective than our average grant, and our best guess for the cost-effectiveness of this specific grant may evolve over time.2 Nevertheless, the general approach described here illustrates our high-level process for estimating the impact of our grants.
What $3,000 could accomplish with Malaria Consortium in Nigeria
| Metric | Explanation | |
|---|---|---|
| Step One: | 2,189 monthly courses of preventive malaria treatment delivered |
The cost of delivering one monthly course (or "cycle") of treatment is about $1.37, so $3,000 in donations can fund the delivery of about 2,189 cycles of medication.3 |
| Step Two: | 498 children protected by the treatments for the high-transmission season |
Courses of preventive malaria medication are delivered over either a four-month or five-month period, depending on the intensity of malaria seasonality in each state. On average, there are 4.4 monthly cycles delivered, so 498 children under the age of five will receive treatments for the full high-transmission season.4 |
| Step Three: | 4.1 children in the protected population5 are expected to die from malaria6 every year |
In order to estimate how many lives the treatments might save, we first need to know how many people in this population would have died of malaria without them. The mortality rates and population dynamics in Nigeria suggest that 4.1 children from this population—including both the 498 treated children as well as older children—would die from malaria.7 |
| Step Four: | 2.9 of those deaths are expected to occur during the high-transmission season |
Based on guidance from the World Health Organization on treatment eligibility and the results of an academic study, we roughly estimate that about 70% of annual malaria deaths in Nigeria occur in the high-transmission season during which the preventive malaria treatments provide protection.8 |
| Step Five: | 1.3 lives are saved by the preventive malaria treatments |
Based on the results of academic studies9 on their effectiveness, we estimate that SMC will reduce these deaths by 46%. In our initial estimate, this donation will avert 1.3 deaths.10 |
| Step Six: | 1.0 life is saved by this donation once we account for its effect on other funders |
Donations can affect the behavior of other funders. In this case, we expect this $3,000 donation will cause other funders to shift some amount of their giving from preventive malaria treatments to other programs. We account for that to give a true estimate of impact. Once we adjust for the impact of that reduced funding, we estimate that this donation will save one life.11 You can read more about how we account for the behavior of other funders here. |
Other benefits
That $3,000 donation may also accomplish some additional outcomes that are not explicitly incorporated into the above cost-effectiveness outline. These benefits include:
- Potential economic effects. Some evidence suggests that averting a case of malaria in children will allow those children to earn more money later in life. As of December 2023, we estimate that these benefits account for approximately 20% to 35% of the total modeled benefits for this intervention in Nigeria (varying by location).12
- Averted non-fatal malaria infections. Non-fatal infections can still cause a significant amount of suffering, including potentially significant neurological and cognitive impairments or anemia.13
- Averted medical costs. Antimalarial medicine may also avert costs for households and the medical system by not needing to treat additional cases of malaria.14
You can find more information about other benefits and downsides that are not explicitly modeled here.
We hope that this was helpful to understand, at a very high level, some of the concepts that we incorporate and the judgments we make in our research. If you have any feedback for us, please fill out this form.
Sources
| Document | Source |
|---|---|
| GiveWell, "Seasonal malaria chemoprevention," 2024 | Source |
| GiveWell, Simplified cost-effectiveness analysis, 2024 | Source |
- 1
Note that the same program can vary widely in cost-effectiveness across locations. For a more detailed and updated version of our cost-effectiveness analyses, see our full cost-effectiveness models.
- 2
The example here is based on our cost effectiveness-analysis as of February 2024, so the numbers may not precisely match our current cost-effectiveness analysis for seasonal malaria chemoprevention.
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We include older children in the protected population because we believe that delivering antimalarial medication to children under five disrupts malaria transmission, reducing malaria in the wider (untreated) population.
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This includes indirect malaria mortalities. This could include, for example, people whose cases of malaria made them more susceptible to deaths from other diseases.
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You can see our analysis on malaria seasonality in our full intervention report on seasonal malaria chemoprevention: GiveWell, Seasonal malaria chemoprevention, "How seasonal is malaria mortality?"
Multiplying 4.1 deaths annually by 70% of deaths during the malaria season results in 2.9 deaths during the malaria season. GiveWell, Simplified cost-effectiveness analysis, 2024
- 9
You can see the details of our review of the academic studies in our full intervention report on seasonal malaria chemoprevention: GiveWell, Seasonal malaria chemoprevention, “What is the impact of SMC on malaria?”
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For more information on our approach to modeling the income effects, see our full intervention report on seasonal malaria chemoprevention: GiveWell, Seasonal malaria chemoprevention, “Long-term income increases”
- 13
For more information on our approach to incorporating these adjustments, see our full intervention report on seasonal malaria chemoprevention: GiveWell, Seasonal malaria chemoprevention, “Additional benefits and downsides”
- 14
For more information on our approach to incorporating these adjustments, see our full intervention report on seasonal malaria chemoprevention: GiveWell, Seasonal malaria chemoprevention, “Additional benefits and downsides”